Cancer mortality in India: a nationally representative survey

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• 作者：Rajesh Dikshit ; PhD^a ; Prakash C Gupta ; DSc^c ; Chinthanie Ramasundarahettige ; MSc^h ; Vendhan Gajalakshmi ; PhD^b ; Lukasz Aleksandrowicz ; MSc^h ; Rajendra Badwe ; MS^a ; Prof Rajesh Kumar ; MD^d ; Sandip Roy ; MD^e ; Wilson Suraweera ; MSc^h ; Freddie Bray ; PhDⁱ ; Mohandas Mallath ; MD^a ; Poonam K Singh ; PhD^f ; Dhirendra N Sinha ; MD^f ; Arun S Shet ; MD^g ; Hellen Gelband ; PhD^j ; Prof Prabhat Jha ; DPhil^h ; ^jhap@smh.ca ; for the Million Death Study Collaborators^&Dagger ;
• 刊名：The Lancet
• 出版年：2012
• 出版时间：12-18 May, 2012
• 年：2012
• 卷：379
• 期：9828
• 页码：1807-1816
• 全文大小：674 K

文摘

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Summary

Background

The age-specific mortality rates and total deaths from specific cancers have not been documented for the various regions and subpopulations of India. We therefore assessed the cause of death in 2001-03 in homes in small areas that were chosen to be representative of all the parts of India.

Methods

At least 130 trained physicians independently assigned causes to 122?29 deaths, which occurred in 1¡¤1 million homes in 6671 small areas that were randomly selected to be representative of all of India, based on a structured non-medical surveyor's field report.

Findings

7137 of 122?29 study deaths were due to cancer, corresponding to 556?00 national cancer deaths in India in 2010. 395?00 (71 % ) cancer deaths occurred in people aged 30-69 years (200?00 men and 195?00 women). At 30-69 years, the three most common fatal cancers were oral (including lip and pharynx, 45?00 [22¡¤9 % ]), stomach (25?00 [12¡¤6 % ]), and lung (including trachea and larynx, 22?00 [11¡¤4 % ]) in men, and cervical (33?00 [17¡¤1 % ]), stomach (27?00 [14¡¤1 % ]), and breast (19?00 [10¡¤2 % ]) in women. Tobacco-related cancers represented 42¡¤0 % (84?00) of male and 18¡¤3 % (35?00) of female cancer deaths and there were twice as many deaths from oral cancers as lung cancers. Age-standardised cancer mortality rates per 100?00 were similar in rural (men 95¡¤6 [99 % CI 89¡¤6-101¡¤7] and women 96¡¤6 [90¡¤7-102¡¤6]) and urban areas (men 102¡¤4 [92¡¤7-112¡¤1] and women 91¡¤2 [81¡¤9-100¡¤5]), but varied greatly between the states, and were two times higher in the least educated than in the most educated adults (men, illiterate 106¡¤6 [97¡¤4-115¡¤7] vs most educated 45¡¤7 [37¡¤8-53¡¤6]; women, illiterate 106¡¤7 [99¡¤9-113¡¤6] vs most educated 43¡¤4 [30¡¤7-56¡¤1]). Cervical cancer was far less common in Muslim than in Hindu women (study deaths 24, age-standardised mortality ratio 0¡¤68 [0¡¤64-0¡¤71] vs 340, 1¡¤06 [1¡¤05-1¡¤08]).

Interpretation

Prevention of tobacco-related and cervical cancers and earlier detection of treatable cancers would reduce cancer deaths in India, particularly in the rural areas that are underserved by cancer services. The substantial variation in cancer rates in India suggests other risk factors or causative agents that remain to be discovered.

Funding

Bill & Melinda Gates Foundation and US National Institutes of Health.